4. List all Business entities in which you personally own an interest of 10% or more

Business 1:

Business 2:

Business 3:

Business 4:

Business 5:

Wholly owned Subsidiary 1:

Wholly owned Subsidiary 2:

Wholly owned Subsidiary 3:

Wholly owned Subsidiary 4:

Wholly owned Subsidiary 5:

Additional business or wholly owned subsidiaries :

5. List all business entities in which your spouse owns an interest of 10% or more

Business 1:

Business 2:

Business 3:

Business 4:

Business 5:

Additionalspouse ownedbusinesses:

6. List all of the business entities not included in #4 or #5 above in which you, your spouse and your dependant children, collectively, own an interest of 10% or more

Business 1:

Business 2:

Business 3:

Business 4:

Business 5:

Additionalcollectively ownedbusinesses:

7. List all other businesses entities, other than publicly traded corporations, from which you, your spouse and your dependant children, collectively, earn, or will earn, more than $10,000 per annum in unearned income.

Business 1:

Business 2:

Business 3:

Business 4:

Business 5:

Additionalbusinesses:

8. List all of the entities for which you, your spouse and your dependent children serves as a director, officer or trustee, other than uncompensated service on the Board of a 'not for profit' corporation.

Entity 1:

Entity 2:

Entity 3:

Entity 4:

Entity 5:

Additionalentities:

9. What business relationships do you , your employer, your spouse, your spouse's employer or entities in which you have a substantial interest, currently have with the University ?

10. What other business interests do you have, that are not disclosed above, that could cause a conflict of interest or the appearance of a conflict of interest, with the University ?